Upper gastrointestinal bleeding secondary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Upper gastrointestinal bleeding}} | {{Upper gastrointestinal bleeding}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Effective measures for the secondary prevention of UGIB include discouraging the use of [[NSAIDS]] in all patients with a history of UGIB. For patients who are at high risk for rebleeding (elderly patients; those taking [[Anticoagulants|anticoagulan]]<nowiki/>t and [[Antiplatelet agents|antiplatelet medications]]), indefinite use of a [[PPI]] may be recommended. A combination of nonselective [[β-blockers]] plus [[EVL]] is the best option for secondary prophylaxis of UGIB from [[varices]]. | |||
==Secondary | ==Secondary prevention== | ||
Effective measures for the secondary prevention of UGIB include discouraging the use of [[NSAIDS]] in all patients with a history of UGIB.<ref name="pmid22142030">{{cite journal |vauthors=Chan FK |title=Anti-platelet therapy and managing ulcer risk |journal=J. Gastroenterol. Hepatol. |volume=27 |issue=2 |pages=195–9 |year=2012 |pmid=22142030 |doi=10.1111/j.1440-1746.2011.07029.x |url=}}</ref> | |||
===UGIB from peptic ulcer disease=== | |||
* | *Avoid using [[NSAIDs]]. | ||
* | *For patients who are at high risk for rebleeding (elderly patients; those taking [[Anticoagulants|anticoagulant]] and [[Antiplatelet agents|antiplatelet]] medications), indefinite use of a [[PPI]] may be recommended.<ref name="Garcia-TsaoSanyal2007">{{cite journal|last1=Garcia-Tsao|first1=Guadalupe|last2=Sanyal|first2=Arun J.|last3=Grace|first3=Norman D.|last4=Carey|first4=William D.|title=Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis|journal=The American Journal of Gastroenterology|volume=102|issue=9|year=2007|pages=2086–2102|issn=0002-9270|doi=10.1111/j.1572-0241.2007.01481.x}}</ref> | ||
* | *[[Helicobacter pylori|H pylori]] status should be determined, and patients should be treated if positive. | ||
**[ | *Eradication is confirmed with [[Stool examination|stool sample]] or repeat [[endoscopy]] with [[biopsy]]. | ||
===UGIB from varices=== | |||
*A combination of nonselective [[β-blockers]] plus [[EVL]] is the best option for secondary prophylaxis of UGIB from [[varices]]. | |||
*The nonselective [[Β-blockers|β-blocker]] should be titrated up as tolerated. | |||
*Variceal [[Banding (medical)|banding]] should be repeated every 2 to 3 weeks until the [[varices]] are obliterated. | |||
**[[Esophagogastroduodenoscopy|EGD]] must be performed 1 to 3 months after initial obliteration then every 6 to 12 months to check for [[Esophageal varices|variceal]] recurrence. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Latest revision as of 15:55, 6 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB. For patients who are at high risk for rebleeding (elderly patients; those taking anticoagulant and antiplatelet medications), indefinite use of a PPI may be recommended. A combination of nonselective β-blockers plus EVL is the best option for secondary prophylaxis of UGIB from varices.
Secondary prevention
Effective measures for the secondary prevention of UGIB include discouraging the use of NSAIDS in all patients with a history of UGIB.[1]
UGIB from peptic ulcer disease
- Avoid using NSAIDs.
- For patients who are at high risk for rebleeding (elderly patients; those taking anticoagulant and antiplatelet medications), indefinite use of a PPI may be recommended.[2]
- H pylori status should be determined, and patients should be treated if positive.
- Eradication is confirmed with stool sample or repeat endoscopy with biopsy.
UGIB from varices
- A combination of nonselective β-blockers plus EVL is the best option for secondary prophylaxis of UGIB from varices.
- The nonselective β-blocker should be titrated up as tolerated.
- Variceal banding should be repeated every 2 to 3 weeks until the varices are obliterated.
References
- ↑ Chan FK (2012). "Anti-platelet therapy and managing ulcer risk". J. Gastroenterol. Hepatol. 27 (2): 195–9. doi:10.1111/j.1440-1746.2011.07029.x. PMID 22142030.
- ↑ Garcia-Tsao, Guadalupe; Sanyal, Arun J.; Grace, Norman D.; Carey, William D. (2007). "Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis". The American Journal of Gastroenterology. 102 (9): 2086–2102. doi:10.1111/j.1572-0241.2007.01481.x. ISSN 0002-9270.